Sinusitis in children
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of sinusitis in children
- Diagnostics
- Treatment of sinusitis in children
- Potential consequences and complications
- Forecast
- Prevention
Sinusitis in children is an inflammation of the maxillary paranasal (maxillary) sinuses, which is often found in pediatric practice. The incidence of sinusitis has a pronounced seasonality - it increases sharply in the autumn-winter period, which is explained by the natural decrease in the immunity of the body of children during this period of time.
In children under the age of 3-4 years, sinusitis does not happen, this is due to age-related anatomical features: by the time the child is born, the maxillary sinuses are in their infancy, their development begins after 5-6 years and lasts up to 10-12 years. Therefore, from 5 to 12 years of age, sinusitis in children is rare, and after 12 years of age, its incidence becomes as high as among adult patients, and is 10 cases for every 100 people.
With sinusitis in children, there is inflammation in the maxillary sinuses of the nose
Causes and risk factors
The maxillary sinuses communicate with the nasal cavity through small openings. If, for any reason (more often due to inflammatory edema of the nasal mucosa), these openings are closed, then the sinuses cease to be cleared and ventilated. This creates a favorable environment in them for the vital activity of pathogenic microflora, which causes the development of an inflammatory process in the mucous membrane of the sinuses.
The causative agents of sinusitis in children are most often viruses. Less often (5-10% of cases), the disease is caused by pathogenic and opportunistic bacterial agents (hemophilus influenzae, staphylococci, streptococci, moraxella), even less often - by a fungal infection.
Most often, children are diagnosed with sinusitis after 12 years
Risk factors for the development of sinusitis in children are diseases that contribute to the penetration of infection into the maxillary sinus or disrupt its normal ventilation:
- chronic rhinitis of various etiologies;
- acute respiratory viral infection;
- chronic pharyngitis;
- chronic tonsillitis;
- adenoid vegetation;
- congenital anomaly of the structure of the nasal passages;
- diseases of the teeth of the upper jaw;
- dental interventions on the teeth of the upper jaw;
- curvature of the nasal septum.
Forms of the disease
Sinusitis in children can be catarrhal or purulent. With purulent inflammation, the discharge from the maxillary sinus is purulent or purulent-mucous, with the catarrhal form of the disease - serous. Catarrhal inflammation can turn into a purulent form.
Depending on the route of infection in the maxillary sinus, the following types of sinusitis in children are distinguished:
- rhinogenic - microbes penetrate from the nasal cavity; this is the most common route;
- hematogenous - an infection with a blood flow enters the sinus from another focus of infection in the body;
- odontogenic - the focus of infection is the carious teeth of the upper jaw;
- traumatic.
Inflammation of the maxillary sinus can be unilateral and bilateral.
With purulent sinusitis, pus accumulates in the maxillary sinus
By the nature of the inflammatory process - acute and chronic.
Depending on the morphological changes, chronic sinusitis in children is:
- exudative (catarrhal or purulent) - the predominant process is the formation of exudate (serous or purulent);
- productive (parietal-hyperplastic, atrophic, necrotic, polyposis, purulent-polyposis). With this form of the disease, pronounced changes in the structure of the mucous membrane of the maxillary sinus occur (hyperplasia, atrophy, polyps).
In clinical practice, polypous-purulent and polypous forms of chronic sinusitis are most often encountered.
Symptoms of sinusitis in children
Acute sinusitis begins with a sudden increase in body temperature to 38-39 ° C, accompanied by chills. In rare cases, body temperature remains within normal limits. Children are concerned about pain localized in the area of the root of the nose, forehead, zygomatic bone from the side of the lesion. The pain can radiate to the temple and intensify on palpation. Often the pain takes on a diffuse character, that is, it is perceived as a headache without a clear localization.
On the side of the lesion, nasal breathing is disturbed, with a bilateral process, children are forced to breathe through the mouth.
Discharge from the nose at the onset of the disease has a liquid serous character. Later they become green, cloudy and viscous, dry quickly and form rough crusts in the nasal cavity.
Sinusitis in children is accompanied by headaches, runny nose, impaired nasal breathing
Swelling of the nasal mucosa often leads to compression of the lacrimal canal. As a result, the lacrimal fluid cannot flow into the nasal cavity and lacrimation occurs.
Signs of sinusitis in children are often regarded by parents as manifestations of ARVI. However, the approach to the treatment of these diseases is different, so it is important that a pediatrician and, if necessary, an otolaryngologist examined the sick child.
The outcome of acute sinusitis in children may be recovery, or the transition of the disease to a chronic form.
In the stage of remission with chronic sinusitis in children, there are no signs of the disease. Children feel healthy and do not have any complaints. With an exacerbation of the inflammatory process, symptoms of intoxication occur (muscle pain, weakness, headache, loss of appetite) and the body temperature rises to subfebrile values (up to 38 ° C). The amount of discharge from the nose increases.
If, with an exacerbation of chronic sinusitis, there is a violation of the outflow from the maxillary sinus, a headache occurs. It has a bursting or pressing character and is localized behind the eyes. Pressure on the eyes and cheekbones, looking up, contribute to an increase in pain. In the supine position, the outflow from the maxillary sinus improves, and therefore the intensity of the headache decreases.
Another symptom of chronic sinusitis in children is a cough that occurs at night and does not respond to traditional therapy. The appearance of a cough is due to the fact that in the supine position, pus from the affected maxillary sinus flows down the posterior wall of the pharynx and irritates it, that is, the cough is of a reflex nature.
In chronic sinusitis in children, on the eve of the nasal cavity, damage is often detected (weeping, maceration, swelling, cracks).
Diagnostics
Diagnosis of sinusitis in children is carried out on the basis of the characteristic clinical picture of the disease, complaints of the patient (or his parents), the results of a medical examination and laboratory and instrumental studies.
When carrying out rhinoscopy, inflammation of the mucous membrane of the nasal cavity, its swelling, and the discharge of inflammatory exudate from the sinus are revealed.
X-rays are taken to confirm the diagnosis. With sinusitis, a darkening of the maxillary sinus from the side of the lesion is noticeable on the roentgenogram, however, it should be borne in mind that the roentgenogram of an acute inflammatory process, especially at the onset of the disease, may be of little information.
To diagnose sinusitis in children, rhinoscopy and radiography are performed
If necessary, conduct a bacteriological examination of the discharge from the nose with the determination of the pathogen and its sensitivity to antibacterial agents.
Treatment of sinusitis in children
With uncomplicated acute sinusitis in children, treatment is usually conservative, carried out on an outpatient basis. The therapy regimen includes:
- antibacterial drugs (eliminate the pathogen);
- non-steroidal anti-inflammatory drugs (have antipyretic, analgesic and anti-inflammatory effects);
- vasoconstrictor nasal drops (improve outflow from the affected sinus).
In the absence of the effect of the conservative treatment of sinusitis, children are hospitalized in a specialized department for punctures or probing of the maxillary sinuses.
In the treatment of sinusitis, children are prescribed antibiotics in tablets
With an exacerbation of chronic sinusitis in children, treatment should be comprehensive, combining methods of local and general therapy.
To suppress the microbial flora, antibiotics are prescribed, selected taking into account the sensitivity of the pathogen. If the causative agent of the disease is staphylococcus, then staphylococcal γ-globulin, antistaphylococcal plasma are used. Treatment of sinusitis in children of fungal etiology is carried out with antifungal drugs.
If necessary, drain the affected sinus. In the future, through the drainage tube, the sinus is washed with antiseptic solutions, antibiotics are administered taking into account the sensitivity of microflora or antifungal drugs to them. Enzyme preparations can be used to liquefy pus and drain it better.
In the stage of remission of chronic sinusitis, children are recommended to carry out physiotherapeutic methods of treatment (mud therapy, microwave currents). With cystic, polyposis and hyperplastic forms of the disease, physiotherapy is contraindicated.
Pumping out pus from the maxillary sinuses
With the ineffectiveness of conservative treatment of exudative forms, as well as with mixed or polyposis forms of the disease, surgical treatment is performed. Most often, radical operations are performed, the purpose of which is to form an artificial fistula between the maxillary and nasal cavities (methods according to Dlicker - Ivanov, Caldwell - Luke).
Potential consequences and complications
Sinusitis in children, especially in the absence of timely adequate treatment, can lead to the development of a number of serious complications:
- keratitis, conjunctivitis;
- orbital phlegmon;
- optic neuritis;
- periostitis of the orbit;
- edema, abscess of retrobulbar tissue;
- panophthalmos (inflammation of all membranes and tissues of the eyeball);
- arachnoiditis;
- meningitis;
- brain abscess;
- thrombophlebitis of the superior longitudinal or cavernous sinus;
- septic cavernous thrombosis.
Chronic sinusitis in children often becomes the cause of blockage of the mucous glands, as a result of which small pseudocysts and true cysts of the maxillary sinus are formed.
Forecast
With acute sinusitis in children, in the conditions of timely initiation of therapy, the prognosis is in most cases favorable. In the chronic form of the disease, it is often necessary to carry out surgical treatment aimed at restoring normal ventilation of the maxillary sinus. After surgery, the disease usually goes into long-term remission.
Prevention
Prevention of sinusitis in children includes:
- humidification of air in the room;
- the child's compliance with the water regime;
- the use of nasal saline sprays or saline solution in the treatment of rhinitis, which not only fight infectious agents, but also moisturize the nasal mucosa;
- in case of acute rhinitis or exacerbation of chronic rhinitis, it is advisable to refuse to travel with a child on an airplane (if this is not possible, then a vasoconstrictor should be used before the flight, and a saline spray in flight).
Swimming in public pools with chlorinated water is contraindicated for children suffering from chronic sinusitis.
With frequent exacerbations of sinusitis, children are referred for consultation to an allergist.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
